Patient education and vaccine awareness campaigns are helping more people understand the connection between human papillomavirus (HPV) and reproductive cancers like cervical cancer. But fewer people understand the relationship that also may exist between head and neck cancers and this sexually transmitted infection.
About 80 million Americans are infected with one of the many types of HPV, according to the Centers for Disease Control and Prevention (CDC). The virus can infect the anus, genitals and oropharynx (tonsils and back of throat) as a result of genital, anal and oral sex. Certain HPV types can cause genital warts, which are considered low-risk.
But other types of HPV can cause cancer in different areas of the body, including the genitals and throat, and are considered to be high-risk. More than one in five adults in the United States has the type of HPV that can cause cancer, according to an April 2017 CDC report.
The incidence of head and neck squamous cell carcinoma (HNSCC) has been gradually increasing over the last three decades. About 7 percent of Americans have oral HPV, which is three times more common in men than women. In some people, oral HPV infection leads to HPV-OSCC (HPV-positive oropharyngeal squamous cell cancer) many years after contracting the infection.
Both head and neck cancers are treated similarly—whether or not they are caused by or related to HPV. Treatment decisions are based on:
- Size of the tumor
- Location of the tumor
- Stage of the disease
- Overall health of the patient
- Patient wishes of the patient
Researchers are studying to determine whether cancer treatments should be changed based on the presence or absence of HPV. About 30 to 40 percent of HNSCC patients present with early stage I/II disease, usually using single modality treatments such as radiation or surgery alone. HPV-driven tumors are more sensitive to radiation and to Cisplatin or chemo-based therapy.
The vaccines Gardasil and Cervarix have been shown to help prevent cervical cancer. Gardasil also helps prevent vaginal, vulvar and anal cancers, as well as genital warts. To date, there are no conclusive studies that show similar protection against oropharyngeal cancer. However, with the availability of these vaccines, physicians are hopeful that the incidence of HPV-related throat cancers will decrease over time.
In all cases, vaccines are designed to prevent HPV infections and are recommended for boys and girls before they become sexually active. An open dialogue between patients and providers about HPV, testing and vaccines can mean a better prognosis.
Understanding how the infection spreads is important for prevention. HPV is not spread through touching or kissing. HPV is contagious through genital and oral contact, so the sexual partners of a person diagnosed with HPV also have been exposed. However, since some infections clear up on their own and not all viruses become cancerous, the chance of a partner getting an HPV-related cancer is low.
Still, precautions should be taken. Contracting the virus is avoidable when men and women practice safe sex and communicate about their health and partner history.
Symptoms of HPV may not be present, but this chronic disease stays with a person for a lifetime. So while treatments and breakthroughs can help manage the disease, there is no cure. Using a condom, understanding HPV and knowing one’s own and a partner’s health history is crucial—especially in avoiding a possible cancer diagnosis.
If a partner is female, she should follow normal women’s health guidelines, which include having a routine Pap test. If a partner is male, he does not need any special exams or tests, because there is no routine or standard HPV screening offered for men. Additionally, there is no effective screening test for head and neck cancer.
For more information about HPV or to schedule an appointment with a primary care provider, visit pinnaclehealth.org.
Jose E. Misas, MD, is a board-certified gynecologic oncologist at the PinnacleHealth Women’s Cancer Center.
- HPV is a group of more than 150 related viruses.
- High-risk types of genital HPV can cause cancer of the cervix, vagina, vulva, anus, penis and throat.
- The type of cancer HPV causes most often is cervical cancer.
- Men can get penile HPV cancer.
- In women, HPV infection can also cause cervical, vaginal and vulvar HPV cancers.
- Most HPV infections go away by themselves and don’t cause cancer; however, abnormal cells can develop when high-risk types of HPV don’t go away.
- Genital warts appear as a small bump or groups of bumps in the genital area. They can range in size and shape.
Author: Jose E. Misas, MD